189
Fishermen are particularly prone to infections of the hands
and fingers because of their working environment and the
things that they are required to handle during their work.
For instance, they may be injured by fish spines and bones, by
broken ends of warps and many other things. Minor cuts and
grazes often go unnoticed at the time of injury. Bacteria are
carried into these wounds from fish slime and guts and also
from pieces of metal etc. Infection then develops with
inflammation of the infected area and the formation of pus.
Prevention is always better than cure and it is
recommended that Chlorhexidine Gluconate 20%
(HIBISCRUB) is used to wash hands and forearms after
handling fish of any kind. The Hibiscrub can be used as a soap
or in solution.
Hand anatomy is very complex but two features are
relevant to fishermen:
■ The tissues of the tips of the fingers (the finger pulps) are
completely closed off from the tissues of the remainder of
the fingers. Because of this, infection and the formation
of pus in the finger tip causes a great deal of swelling and
pain. This situation is called a pulp space infection.
■ The hand tendons (which move the fingers) are enclosed
either partially or completely in sheaths (Fig 8.1). A finger
infection may spread along the tendon sheath towards
the communal sheath in the palm. This is particularly
likely when the little finger or thumb is the infected part.
Infection of the palm sheath causes severe pain and
swelling of the hand. This is a palmar space infection.
Figure 8.1 Tendons of the hand;
the tendon sheath does not
cover all of the middle
three tendons.
All finger and hand
infections are very painful
and disabling. Some can
cause permanent
disability. They should be
treated aggressively if
they occur but it is
preferable to prevent
them. Finger and hand
infections can be avoided
by:
■ Thorough washing of the hands at the end of every work
period, preferably with chlorhexidine gluconate 20%
(HIBISCRUB).
■ Prompt treatment and cleaning of all minor cuts,
scratches and abrasions.
■ Aggressive early treatment including antibiotics if
throbbing pain or inflammation is noted anywhere in the
hands or fingers
Infections of the fingers
and hands
Cuts to the hands
(including tendon
injuries)
Salt water boils (pips or
pigeons)
Jumbo wrist
Tit juice conjuctivitis
(fisherman’s conjuctivitis)
Fish erysipeloid (fish
poisoning)
Dogger Bank itch (curly
weed rash)
Removing a fish hook
Diseases of Fishermen
CHAPTER 8
Infections of the fingers and hands
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THE SHIP CAPTAIN’S MEDICAL GUIDE
Specific hand and finger infections
Boils
Boils can occur on any part of the hands or fingers. They are often more painful than boils
elsewhere on the body because the skin on fishermen’s hands is hard and thick and unable to
give. Boils therefore take a long time to come to a head and discharge.
To treat boils, a clean, dry dressing should be applied to the area. Antibiotics should be given
if there is any evidence of spreading infection (e.g. redness going up the arm)
Pulp space infections
These are usually caused by fish bones or spines or by fragments of wire. They cause severe
throbbing pain of the finger tip and require urgent treatment. The patient should be given
antibiotics and the pus must be released by incision using a scalpel. If possible the patient should
be landed, but if this is not possible, the finger should be numbed using local anaesthetic
(Lignocaine 1%) and the palmar surface of the finger incised down to bone in the line of the
finger. Pus will be released in this way. The finger should then be dressed and the patient landed.
Nail fold infections
These are also called whitlows. They are usually caused by minor scratches around the finger
nails. The skin around the nail becomes painful and swollen. As soon as the infection is
suspected it should be treated with oral antibiotics. If the infection comes to a head with pus
present, the finger should be numbed with local anaesthetic (Lignocaine 1%) and a small
incision should be made in the ballooned skin over the pus. The finger should then be dressed
and the patient landed.
Palmar space infections
These are infections of the deep structures of the hand and must be taken very seriously. They
are usually caused by an extension of a deep infection of a finger or of an infection of the
tendon sheath of the thumb or little finger. They can also be caused by a prick in the palm or
a stab wound from a knife in the palm. The most common cause is a finger infection which has
been ignored.
The whole hand becomes swollen, there is severe throbbing pain and this is made worse by
any movement of the fingers. The patient feels generally unwell, with sweating, shivering,
sickness and raised body temperature all being possible. Treatment is urgent to prevent
permanent disability. The patient must be put to bed with the hand elevated and
arrangements must be made to land the patient as soon as possible. Antibiotics
must be given, ideally by injection, until the patient is landed. If in doubt, seek
RADIO MEDICAL ADVICE.
Lymphangitis
This is infection and inflammation of
the lymph channels and commonly
Septic
occurs as a result of finger and hand
finger
infections. It is seen as red lines
spreading up the arms. See Figure 8.2
Lymphpathway
for the pathways along which infection
reddened
passes up the arms. As well as fiery red
Glands
lines up the arms the lymph glands at the
enlarged and
elbow and in the armpits may become swollen and
reddened in
painful. If lymphangitis appears, there is infection
these areas
in the hand until proven otherwise and the patient
should be given antibiotics even if there is no
Figure 8.2 Lymphangitis – septic finger.
obvious source of the infection.
Chapter 8 DISEASES OF FISHERMEN
Haddock Rash
This in an infection of the clefts between the fingers that occurs following gutting white fish,
particularly haddock. Untreated it can caused redness, pain and swelling for several weeks. It
usually responds rapidly to antibiotics, given for five days.
Cuts to the hands (including tendon injuries)
All cuts to the hands should be taken seriously due partly to the high risk of infection from even
minor wounds (see above).
All cuts to the hands and fingers should also raise the possibility of injury to the tendons or
nerves. If the patient is unable to move his fingers normally himself or has reduced sensation in
a finger, there is possible tendon or nerve damage and the patient needs to be landed for
possible surgery.
Salt water boils
These are also called pips or pigeons. They occur because the cuffs of clothing worn by
fishermen rub the sand and grit brought up in nets into the skin of the wrists and the back of the
hands causing tiny abrasions. The cuffs are usually covered with fish slime from sorting and
gutting operations and bacteria in the slime infect the abrasions. Sores appear as small
irritating spots which soon become tiny painful septic blisters. Some become large boils and the
whole of the wrist and back of the hand may become inflamed, hard and painful.
The sores can be prevented by thoroughly washing the hands and wrists after coming off
watch and by frequently scrubbing the cuffs of waterproof coats with soap and fresh water.
When sleeve cuffs become cracked and worn, the garment should be replaced.
Once the sores occur, they should be bathed frequently in warm water and covered with a
dry dressing. If boils develop the patient should be given antibiotics.
Jumbo Wrist
The medical term for this condition is Fishermen’s tenosynovitis of the wrist. It occurs because
prolonged repetitive movements of the wrist can cause inflammation of the sheaths through
which the tendons around the wrist move. It is fairly common when fishermen are involved in
prolonged gutting or when they return to sea after a long period ashore. Wrist movement (as
occurs in gutting) causes localised pain and a sensation of fine grating. This grating (known also
as crepitus) can be felt by placing the palm of the examiner’s hand lightly over the painful place
and asking the patient to carry out the painful movements.
The condition can be treated with anti-inflammatory drugs (e.g. Diclofenac or Ibuprofen)
but often fails to settle whilst the fisherman continues to work. The most effective treatment is
complete rest for a period of 10 – 14 days, preferably with the wrist supported in a splint.
Tit juice conjuctivitis (fishermen’s conjuctivitis)
This is an acute inflammation of the conjuctiva (the thin lining membrane over the eyes) due to
contact with the juice of ‘duffs’ or ‘tits’. These are marine growths which look like suet
dumplings with finger-like growths protruding from them. When they are trawled up they may
burst in the cod end of the net and the juice, which contains tiny sharp silicon particles, may be
squirted into the eyes of the fisherman. It is very irritant to the eyes, causing redness and
inflammation and eventually blistering. The eyes are very painful and this is made worse by
exposure to light. If untreated the eyes may close due to swelling.
The treatment is to wash out the eyes with large amounts of clean, fresh water. Relief from
the pain can be obtained by instilling eye drops (Betamethasone and Neomycin eye drops four
times daily). The eyes must be examined by a doctor on return to port.
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THE SHIP CAPTAIN’S MEDICAL GUIDE
Fish erysipeloid (fish poisoning)
This arises from minor pricks or scratches caused by the bones or fins of fish. Particles of fish or
infected fish slime are carried into the wounds. Inflammation starts as a small red area, the
margins of which become swollen and purple. The inflammation and discoloration spread
rapidly up the arms. The margin remains purple and raised whilst the centre appears only
mildly inflamed. The whole area is swollen and tender and may itch or burn. Lymphangitis (see
above) may occur.
The disease can be prevented by thorough washing with soap and hot water at the end of
every watch. When the disease is diagnosed, treatment should be started with antibiotics.
Dogger Bank Itch (curly weed rash)
ie
rs
This is an allergic skin condition caused by contact with a seaweed-like plant, known to
fishermen as curly weed, which grows in the shallow waters of the North Sea, especially around
the Dogger Bank area. It is also found around Scotland, Norway and Greenland. Not all
fishermen in contact with curly weed develop the rash or become sensitised. Sensitisation can
be very gradual but once established it requires only contact with nets used in the area to
precipitate an attack.
The rash usually appears as a dermatitis on the backs of the hands, wrists and forearms. Once
the allergy is established further contact causes the rash to spread to the face and eyes and
ultimately to the whole body. The affected parts are itchy, red and swollen. Weeping and
drying can cause painful cracks to appear in the skin. When the face and eyes are affected there
is marked swelling around the eyes.
The only effective treatment is to remove the patient from all further contact with curly
weed. He will need to change to deep water ships. The rash usually clears up on going ashore
but in established cases drug treatment may be required. The patient is given antihistamines.
These drugs cause sleepiness; the patient must not be allowed to operate machinery whilst on
these drugs. Steroid ointment (Hydrocortsone 1% cream) should be applied to the affected
parts. Inflammation of the eyes can be treated with eye drops (Betamethasone and Neomycin
eyedrops) and the patient should be landed.
Pl
192
Removing a fish hook
Before attempting to remove the hook, the surrounding
area needs to be numbed using an injection of local
anaesthetic (Lignocaine 1%). Once the area is numb (usually
the finger) the hook and the area of skin around it should be
thoroughly cleaned with antiseptic solution.
Feel for the position of the barb and make sure that the
area is numb, using some more local anaesthetic if necessary.
Grasp the shank of the hook firmly in a pair of pliers.
Following the curve of the hook, push the barb through the
skin until the barb and part of the hook is visible. Clip off the
barb and withdraw the hook, again following the curve of
the hook.
The patient should be given antibiotics due to the high
risk of infection.
Cut barb off at
dotted line
Figure 8.3 Removal of fish hook.